Shoulder Arthritis & Replacement

Shoulder or glenohumeral arthritis occurs over time as joint cartilage is worn down and destroyed, narrowing the joint space. This can be the result of degenerative changes, posttraumatic arthritis or inflammatory arthritis. Patients describe the pain as being worse with any kind of movement or strenuous activity and therefore motion tends to be limited. X-rays will reveal narrowed or negligent remaining joint space between the humeral head and the glenoid. Initial treatment usually consists of rest, NSAIDs, therapy and cortisone injections. Ultimately, depending on the patient’s health and age, a total shoulder arthroplasty may be indicated to alleviate pain and restore some function. If the rotator cuff is also compromised, a reverse total shoulder arthroplasty may be necessary.

Total Shoulder Arthroplasty
Some patients with advanced shoulder arthritis and an intact rotator cuff may be a candidate for a total shoulder arthroplasty (aka total shoulder replacement). It is important to take into consideration the patient’s age and functional status when considering this option. The total shoulder replacement will help decrease pain and allow the patient to return to daily activities. It is generally not designed for heavy laborers or those involved in daily strenuous activities. The surgery involves replacing two components from within the shoulder: the humeral head (ball) and the glenoid (socket). The patient will begin a gentle range of motion shortly after surgery. The patient’s progress will be followed closely by their surgeon and physical therapist at follow-up appointments.

Reverse Total Shoulder Arthroplasty
This surgery is reserved for patients with advanced shoulder arthritis in combination with a torn and retracted rotator cuff. The reverse shoulder arthroplasty changes the dynamics of the shoulder so that the deltoid muscle takes the place of the rotator cuff when elevating the arm. The native humeral head is replaced with the socket portion of the arthroplasty, and the glenoid is replaced with the ball portion of the arthroplasty. Shoulder range of motion will likely still be limited after surgery, but the pain will be relieved once the arthritic joint is replaced.

Most shoulder pain can be treated with rest, anti-inflammatories, and physical therapy. Any primary doctor or general orthopedist can prescribe these simple solutions, but a trained shoulder specialist won’t just treat your pain — they will diagnose and treat your specific problem.

At Modern Orthopaedics, our trained shoulder specialists will ask the right questions, perform specific examinations, and order imaging when appropriate. They will be able to diagnose your problem and treat you whether your problem is simple or complex. Although you may not feel like your shoulder issue is “bad enough” to see a specialist, it is advantageous to have the opinion of an expert in the field when it comes to your health.

Before deciding on the treatment for your shoulder pain, our doctors will first diagnose your problem. Depending on the type and severity of your problem, the treatment options will vary.

Generally, physical therapy will be involved in the first step of treatment. You will work closely with a therapist two to three times a week to develop a routine that is tailored to your diagnosis and needs. Therapy may take some time to help, which is why a six-week trial is generally recommended before proceeding with other treatment options.

Cortisone injections are often used in orthopedics. Our doctors are conservative when it comes to using cortisone injections and reserve them for specific situations. They are most commonly used for patients who may have a stiff or frozen shoulder or shoulder arthritis. They use them less commonly for rotator cuff issues, but there are exceptions. Each patient’s situation is unique, and our doctors will work with you to ensure the highest level of care.

Surgical intervention is reserved for shoulder issues that do not respond to more conservative measures or acute injuries that need to be addressed right away. The most common shoulder surgeries performed by our doctors are done arthroscopically. This allows for smaller incisions and a quicker recovery for our patients. The length of recovery, immobilization period and rehabilitation protocol differ depending on the surgery.

Physical therapy can be extremely helpful in addressing shoulder issues. It will likely be involved in your treatment to some extent, whether it’s to help manage pain, increase strength or mobility, or rehabilitation after surgery. Your therapist will design a program that is unique to your problem and help guide you through exercises and stretches. Generally, we send patients to therapy three times a week so they can develop a consistent routine. We can recommend the names of specific therapists who are particularly skilled in treating shoulder issues. Although therapy is time consuming, it may help you avoid surgery or manage your pain without medication. Physical therapy also helps you to develop good techniques and habits for exercise that you can then use at home.